Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Abstract

Aim

To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity.

Materials and methods

A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6[[ce:hsp sp="0.25"/]]cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5[[ce:hsp sp="0.25"/]]Gy or 16.75[[ce:hsp sp="0.25"/]]Gy prescribed at the 65–67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0.

Results

A total of 40 patients with 55 colorectal liver metastases were included in this study. We delivered 37.5[[ce:hsp sp="0.25"/]]Gy to 32 lesions, and 50.25[[ce:hsp sp="0.25"/]]Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group.

Conclusions

SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.